Entered into our Education Ambassador database, so that groups in your area can contact you directly to request a presentation.

Education Ambassadors are encouraged to seek out opportunities to use these materials in their communities. The National Resource Center will pass along any requests we receive, but we are not able to locate speaking opportunities or organize Ambassador presentations.

Volunteer Education Ambassadors are different from our Certified Trainers. The Certified Trainers have received extensive training on our entire curriculum and are able to facilitate our full range of training products. At this time we are unable to train more Certified Trainers, but if you are interested in becoming a certified trainer, please contact Leon Avelino (lavelino@sageusa.org) and your name will be added to our wait list of potential trainers.

If you are interested in becoming an Education Ambassador, please fill out all fields in the form below.Required fields are marked with *.

First Name*

Last Name*

Degree(s)List e.g. "BA, RN, LCSW"

Organization/Agency/Institution that you are affiliated with:

Address

City*

State*

Zip*

Email*

Phone*

How did you hear about the Education Ambassador Program?*
Internet search
From a friend/colleague/other acquaintance
At a conference or through a workshop
Through an email
Other (please state)

Did you learn about the Education Ambassador Program from a National Resource Center on LGBT Aging training?
Yes
No

If yes, which trainer?

How would you rate your ability to use Microsoft PowerPoint?*
Expert
Very Strong
Strong
Average
Poor

Please answer the follow three questionsin a short paragraph each (300 word limit)

Please describe your personal/professional experience as it relates to working with older adults?*

Please describe your personal/professional experience as it relates to working with the LGBT population? If relevant, please specify which populations in particular (lesbian, gay, bisexual and/or transgender).*

Why do you want to become a National Resource Center on LGBT Aging Education Ambassador?*

In the event you are selected as a Volunteer Education Ambassador, we will need a brief bio to add to your information available on our website. Please provide a brief biographical statement of 75 words or less. Note that we may edit for grammar and spelling, as needed.*

Please read the following three statements and signal your agreement by checking each box.

By registering to become an Education Ambassador I agree:*
To be available to give presentations in my area
To inform the National Resource Center on LGBT Aging when I schedule a presentation
To provide feedback on my presentations through the online survey
To have my name and contact information listed on the National Resource Center on LGBT Aging's website

The National Resource Center on LGBT Aging is supported, in part, under a cooperative agreement from the U.S. Department of Health and Human Services, Administration on Aging. Grantees undertaking projects under government sponsorship are encouraged to freely express their findings and conclusions. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and endorsement by the Federal Government should not be assumed. All Rights Reserved.